Thomas F. Lüscher, FESC, FAHA, FRCP CRT 2017, Washington, DC, USA How do I Treat Today‘s Patient with Resistant Hypertension in My Practice? Thomas F. Lüscher, FESC, FAHA, FRCP Professor and Chairman of Cardiology and Director, Center for Molecular Cardiology, University and University Hospital Zurich www.tomluescher.ch

Boston Scientific Research Grant Medtronic Research Grant CRT 2017, Washington, DC, USA Disclosure: Boston Scientific Research Grant Medtronic Research Grant St. Jude Educational Grant

Managing Treatment-Resistant Hypertension: Basics for the Definition Life Style Changes Antihypertensive Drugs Exercise Weight Loss Moderate Salt Diet Potassium Supplementation Calcium Antagonist ACE-Inhibitor or ARB Chlorthalidone or Torasemid

Managing Treatment-Resistant Hypertension: Confirmation by 24h Ambulatory BP Measurement

Managing Treatment-Resistant Hypertension: Excluding Systolic Hypertension

Managing Treatment-Resistant Hypertension: Excluding Secondary Hypertension Clinical: BMI Body shape Murmur Diet Imaging: Ultrasound CR Scan Angiography Renal artery stenosis Conn‘s Syndrome Cushing syndrome Pheochromocytoma Aortic Isthmus stenosis Hormone Mea- surements: PRA Aldosterone Cortisol Metanephrine

Anatomy Access Guiding catheter Device Managing Treatment-Resistant Hypertension: Evaluation for Renal Nerve Ablation Anatomy Access Guiding catheter Device

Anatomy of Renal Sympathetic Nerves

Impact of Number of Ablations on Change in Office SBP: Symplicity HTN-3 Matched Cohort Analysis 166 155 134 100 63 46 27 19 10 N=163 152 131 98 61 45 26 18 9 P value for trend= 0.01 Baseline SBP 178.2 180.1 178.6 180.3 178.2 180.5 179.0 179.4 179.1 179.7 178.3 181.3 181.9 182.3 183.2 182.8 185.4 189.4 95% CI P* -1.7(-7.1, 3.7) 0.54 -3.1 (-8.6, 2.4) 0.27 -5.4 (-11.3, 0.5) 0.07 -7.1 (-13.9,-0.3) 0.04 -8.4 (-17.4, 0.7) -11.5 (-21.8,-1.2) 0.03 -14.1 (-28.8, 0.7) 0.06 -12.0 (-30.0, 5.9) 0.18 -12.4 (-44.6, 19.8) 0.43 Propensity scores using baseline characteristics as covariates were used to match sham control and denervation patients *P value change in SBP for RDN compared with sham Data presented are mean (SD) David E. Kandzari et al. EuroPCR 2014

The Zurich RNA Registry Personal Experience: The Zurich RNA Registry

Thank You! CRT 2017, Washington, DC, USA How do I Treat Today‘s Patient with Resistant Hypertension in My Practice? Difficult to treat hypertensives Exclusion of secondary hypertension Exclusion of systolic hypertension Appropriate antihypertensive regimen Ballon-based Ablation Proper Follow-up Thank You!